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VIEWPOINT
Year : 2022  |  Volume : 59  |  Issue : 1  |  Page : 132-135
 

Can we dream of an integrated pain management app for cancer patients?


1 Department of Anaesthesiology, Teerthanker Mahaveer Medical College, Moradabad, Uttar Pradesh, India
2 Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Date of Submission16-Oct-2020
Date of Decision17-Oct-2020
Date of Acceptance15-Mar-2021
Date of Web Publication19-May-2022

Correspondence Address:
Bhavna Gupta
Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijc.IJC_1183_20

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 » Abstract 


The cancer burden continues to grow globally, exerting tremendous physical, emotional, and financial strain on individuals, families, communities, and health systems. The number of health-related mobile applications (apps) is increasing rapidly. We searched for pain apps specific for cancer patients on App Store for iOS devices and Google Play for Android devices. An integrated pain management app (IPMA) is the need of the hour, which will not only provide a platform to users to assess their pain scores but also assess other associated symptoms and can provide a step-wise assessment to their symptomatology. This can offset the patient burden in the outpatient pain clinic and reduce the number of follow-up visits by addressing common concerns that can be tackled easily at home.


Keywords: Cancer pain management, Mobile devices,Mobile pain app


How to cite this article:
Ahluwalia P, Gupta B. Can we dream of an integrated pain management app for cancer patients?. Indian J Cancer 2022;59:132-5

How to cite this URL:
Ahluwalia P, Gupta B. Can we dream of an integrated pain management app for cancer patients?. Indian J Cancer [serial online] 2022 [cited 2022 Jul 7];59:132-5. Available from: https://www.indianjcancer.com/text.asp?2022/59/1/132/345478





 » Introduction Top


Cancer is a major public health problem and is the second most common cause of mortality worldwide.[1] The cancer burden continues to grow globally, exerting tremendous physical, emotional, and financial strain on individuals, families, communities, and health systems. The National Cancer Registry Program Report 2020, released by the Indian Council of Medical Research (ICMR), estimated there will be 13.9 lakh cases of cancer in India in 2020, and that this number is likely to rise to 15.7 lakh by 2025.[2] The number of new cancer cases is increasing rapidly every year. Furthermore, the incidence of persistent cancer pain during treatment has also increased. According to reports, approximately 69% of patients with cancer worldwide experience pain during their daily activities, which may have serious psychosocial consequences, including anxiety and depression.[3] There is an increase in discomfort as the disease advances, or there could be side effects of treatments such as chemotherapy and radiotherapy and side effects of pain medications or interventional treatments. According to reports, only 25% of patients with advanced cancer have pain that can be relieved, especially out-of-hospital patients, who have a lower pain relief rating than patients in the hospital.[3] The anticipated rise in the number of patients means there will be more people struggling with the symptoms and side effects of their disease.

The number of health-related mobile applications (apps) is increasing rapidly. Apps for pain management are also gradually evolving. We searched for pain apps specific for cancer patients on App Store for iOS devices and Google Play for Android devices. Various parameters such as the name of the app, availability in operating systems (iOS or Android), download cost, creation dates, date of latest update, language, type of cancer, user rating, number of downloads, reviews, type of target population, the objective of the app, and the target population were explored. The last search was made on October 15, 2020. We analyzed various elements of the apps that may improve the usability and help patients in cancer pain management. We analyzed that all the apps available were for general pain, shoulder pain, abdominal pain, labor pain, knee pain, or headache. Many apps are also available for specific cancers such as breast cancer, endometrial cancer, or lung cancer, but none of them specifically pertains to cancer pain assessment and management. We found that many of the commercially available apps lacked usability and had limitations, such as the absence of a rigorous scientific evaluation of the provided content and the recommendations given to the patients. The various apps available for cancer and pain are summarized in [Table 1]. Among the available pain management apps, none are comprehensive for cancer pain management, and most only contain a pain diary module.
Table 1: All available cancer and pain apps in play store with good rating

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 » Need for an Integrated Pain Management App Top


An integrated pain management app (IPMA) is the need of the hour, which will not only provide a platform to users to assess their pain scores but also assess other associated symptoms and can provide a step-wise assessment to their symptomatology. This can offset the patient burden in the outpatient pain clinic and reduce the number of follow-up visits by addressing common concerns that can be tackled easily at home. It has been found that cancer patients have an increased level of stress, secondarily to disease process, pain, effects of radiotherapy, chemotherapy, surgery, and so on. To reduce stress, the integrated mobile app can provide a separate section for assessment of distress and can definitely go a long way in reducing the stress in these patients by guiding the patients to do deep breathing exercises, yoga, meditation, music therapy, and so on, and setting reminders in a smartphone that beeps to signal and guides the patients to do the next task. The issue of cancer pain is multifaceted, and it is imperative to consider the mind, the body, and the spirit while managing it. Palliative care challenges during the current COVID-19 (coronavirus disease 2019) pandemic needs a special mention. The patients were not able to visit the pain clinics because of the lockdown, shut down of pain clinics, diversion of manpower to essential areas such as intensive care units (ICUs) and COVID-19 patients management. IPMA can prove to be beneficial for patients staying in remote locations with a lack of access to good tertiary care centers. Previous studies have proven that cancer patients experience pain and fatigue, which in turn lead to dependence, physical helplessness, and incapability of doing what they want to do.[3] IPMA can help in providing comfort, reduce stress, and help in preoperative optimization of cancer patients awaiting surgery by addressing various concerns such as pain, vomiting, diarrhea, and so on. A draft of our IMPA app is highlighted in [Figure 1]a and [Figure 1]b.
Figure 1: (a and b) Integrated pain app structure

Click here to view


Blödt et al.[4] reported that patients using the app had pain for fewer days and needed less pain medication compared with the control group. Guillory et al.[5] found significant improvements in pain interference with general activities, pain interference with sleep, pain interference in relation to others, and positive affect for the app users compared with the control group during the intervention period. Statistically significant improvements in functionality, well-being, productivity, and presenteeism at work were reported for the treatment group compared with the control group.[6] Patients with acute pain need to be treated carefully to prevent the abuse of pain medication, in particular the abuse of opioids, and to avoid conversion to chronic pain. IPMA can assist in monitoring the patients with acute or chronic pain and can inform and support them in the management of pain, for example, changes in the dosage of analgesics, early detection of adverse effects of analgesics, or providing coping strategies to manage pain.

We strongly feel that there is an immense need for a good IPMA for cancer patients. There is a need for a feasible, effective, and low-cost pain management tool for cancer patients and health care professionals. In the management of patients with pain, apps can provide various features such as pain diary, educational features, reminders, treatment recommendation aspects, and direct communication with health care personnel in a single mobile app. Patient-centered apps are definitely helpful because they can connect patients and clinicians in real time to address many issues related to disease progression and symptomatology before they become a challenging crisis. These apps can work at various levels in patient management, starting from preemptive assessment, optimization, pain management, other symptom-based management, stress reduction, yoga, meditation, and integrative management. IPMA will have an objective pain inventory to precisely report pain scores. IPMA will incorporate modern technology, such as visual interactivity and touchscreens, to help patients better understand the reporting procedures and provide effective guidance for them to report pain. IPMA may prove beneficial for patients on an outpatient department treatment (OPD) basis. The patients can be provided helpful feedback, coaching, education, and knowledge about the disease and alert the health care team at the same time to emerging problems. Mobile apps can provide many benefits and opportunities for the improvement of medical care by allowing real-time pain recording and intervention among cancer patients with pain. There is an immense need for IPMA that monitors patient's self-reported pain and uses artificial intelligence to differentiate urgent and nonurgent issues, and provide real-time solutions to reduce pain significantly and reduce the rate of hospital admission related to pain issues. IPMA will send daily tips for effective pain management. Depending on the pain score, as mild to moderate pain, the app will provide tailored educational feedback on self-management. IPMA can provide instant messaging modules. If the patient is still not relieved or pain worsens, IPMA can alert a nurse who will respond within 30 minutes. IPMA can provide comfort and reduce anxiety. The app can assist by providing psychological support by means of various blogs or article links that are provided in the app. Furthermore, intelligent systems such as chatbots or virtual assistants are already part of daily life for many people. IPMA should be introduced into telehealth shortly, and their testing for validity and usability is crucial. IPMA will address various issues such as stress relief; will have peer group discussions related to patient's symptoms, mediation, and yoga exercises; and will be available on the app. Patients can set reminders to take medications and improve their sleep hygiene. For patients planned for surgery, it can provide a platform for open discussion with oncosurgeons, anesthesiologists, physiotherapists and other specialists. Special sections on exercises to treat lymphedema, breathing exercises, and so on, under the guidance of an expert physiotherapist can be made available. IPMA can also provide an option to choose the language in which the patient understands and comprehends (availability of special feature of app translation in a regional language is always appreciated).

IPMA can provide a special section for the caregivers because they are the most important task manager of any cancer patient. They can watch the patients for signs of pain, confusion, dizziness, vomiting, and so on, and a standard approach to system management can be incorporated in an app-based system, starting from symptomatology assessment, next step in management, and so on, in a step-wise approach. Caregivers can notice subtle signs of moaning, grimacing, and tension on face and can check for dizziness secondary to drug intake, unusual vomiting, constipation, or diarrhea. If the patient seems forgetful, caregivers can track medications to avoid over- or underdosing. They can suggest enjoyable activities to distract patients. They can help patients go through the app-based management. Correspondingly, high-quality studies for the evaluation of the efficacy of these new apps are required. These apps should also be evaluated and analyzed systematically. Thus, it is important to create apps that are endorsed by health organizations, not only for research purposes but also to provide continuous support to patients, health care professionals, and caregivers of cancer patients. At present, caution should be taken in the use of available apps, social networks, and websites because of the lack of evidence supporting their use. It is also necessary to create apps for all age-groups because most of the research is done in younger populations.


 » Conclusion Top


Undoubtedly, mobile technologies will develop further and an IPMA can address concerns of cancer patients, and it is need of the hour that these guidelines provided on the app be based on recommendations. IPMA will have a significant impact on reducing negative attitude towards pain treatment in cancer patients. It will also help in reducing hospital burden and improving patient satisfaction.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 » References Top

1.
Ma X, Yu H. Global burden of cancer. Yale J Biol Med 2006;79:85-94.  Back to cited text no. 1
    
2.
Policy Brief-Report of National Cancer Registry Programme-2020 (ICMR-NCDIR), Bengaluru, India https://ncdirindia.org/All_Reports/Report_2020/PB/Policy_Brief.pdf. [Last accessed 2020 Oct 16].  Back to cited text no. 2
    
3.
Grassi L, Spiegel D, Riba M. Advancing psychosocial care in cancer patients. F1000Res 2017;6:2083.  Back to cited text no. 3
    
4.
Blödt S, Pach D, Eisenhart-Rothe SV, Lotz F, Roll S, Icke K, et al. Effectiveness of app-based self-acupressure for women with menstrual pain compared to usual care: A randomized pragmatic trial. Am J Obstet Gynecol 2018;218:227.e1-227.e9.  Back to cited text no. 4
    
5.
Guillory J, Chang P, Henderson CR, Shengelia R, Lama S, Warmington M, et al. Piloting a text message-based social support intervention for patients with chronic pain: Establishing feasibility and preliminary efficacy. Clin J Pain 2015;31:548-56.  Back to cited text no. 5
    
6.
Irvine AB, Russell H, Manocchia M, Mino DE, Cox GT, Morgan R, et al. Mobile-web app to self-manage low back pain: Randomized controlled trial. J Med Internet Res 2015;17:e1.  Back to cited text no. 6
    


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